About 25% of the population in the US have the metabolic syndrome, a cluster of cardiovascular disease[unreadable] (CVD) risk factors including abdominal obesity, glucose intolerance, elevated blood pressure and[unreadable] dyslipidemia, and this prevalence is even higher in low income groups. The presence of this syndrome[unreadable] increases risk for diabetes by 3-fold and for CVD approximately two-fold. Since obesity, sedentary living and[unreadable] an atherogenic diet are believed to play major roles in the development of the metabolic syndrome, lifestyle[unreadable] modification is considered to be the primary approach to its treatment, although there have been few longterm[unreadable] studies of the efficacy of such programs. This project will compare the effects of a 1-year, structured[unreadable] lifestyle intervention program (Enhanced Care [EC]) in 112 patients (80 completers) with the metabolic[unreadable] syndrome attending an inner city family medicine clinic to that of a matched group receiving standard lifestyle[unreadable] recommendations (Standard Care [SC]) in a randomized clinical trial. By structuring the lifestyle program to[unreadable] modify behavior and improve coping skills, it is predicted that participants will reduce weight by 7% and[unreadable] increase physical activity by at least 150 minutes per week of walking-style exercise. The EC protocol will[unreadable] consist of 4 weekly followed by 4 bi-weekly group sessions making up the Core Curriculum during the first 3[unreadable] months, followed by 9 monthly Maintenance group sessions, and will be delivered by experienced lifestyle[unreadable] managers with expertise in behavior modification among low-income people as well as in subjects from[unreadable] minority ethnic groups. Assessments of metabolic syndrome components, weight, physical activity, health[unreadable] quality of life, psychosocial status, glucose, insulin and lipid and lipoprotein levels, markers of inflammation,[unreadable] coagulation, oxidative stress and endothelial dysfunction, and subclinical CVD measures, will be undertaken[unreadable] at baseline, 6, and 12 months, since it is anticipated that the EC intervention will improve CVD risk factors[unreadable] and reduce the prevalence and intensity of the metabolic syndrome and the pathophysiological factors[unreadable] driving it. This study is intended to demonstrate that a structured program directed at weight reduction and[unreadable] increasing physical activity can be successfully applied to low income patients with the metabolic syndrome.[unreadable] Reducing the frequency and the severity of the metabolic syndrome through effective weight reduction and[unreadable] increased phsycial activity is expected to lower the rate of diabetes and cardiovascular disease in the long[unreadable] term.